Multiple Sclerosis

Presence of _____ on brain and spinal chord support diagnosis of MS

2 lesions

How much more prevalent is MS in women than it is in men?

2-3 times more prevalent

Onset of MS usually occurs between the ages of what?

20 to 50

Approx how old is a pt when the first symptoms of their MS appear?

30-35 years old

What does the plaque in the white matter of the CNS do?

It damages the myelin sheath and interferes with impulse transmission between the CNS and the body

What diagnostic test is used to help diagnosis MS?

MRI

______ is disrupted without the presence of myelin

Nerve impulse transmission

Is there a cure for MS?

No

Name six Sensory manifestations of MS

Numbness and tingling Pain (in low thoracic of ABD regions) Hearing loss Vertigo an tinnitus Chronic neuropathic pain Lhermitte's sign

What are four cerebellar manifestations of MS?

Nystagmus Ataxia Dysarthria Dysphagia

What type of drugs may be prescribed to a pt with MS to tx their depression?

Tricyclic antidepressants

The average life expectancy of MS is ______

greater than 25 years

What are two corticosteroids used to help tx acute exacerbations of MS?

methylprednisolone, prednisone

MS is characterized by the development of ______ in the white matter of the CNS

plaque

What is the overall trend of MS?

progressive deterioration in neurologic function

Inter professional care for MS is aimed at treating the disease process and _____

providing symptomatic relief

What may need to be taught to a pt with MS about urinary elimination?

How to self cath

What are two main side effects of steroids?

Hypervolemia and personality changes

What are the three pathological processes that characterize MS?

1. Chronic inflammation 2. Demylination 3. Closes (scarring) in the CNS

Explain Crede's maneuver...

A maneuver done by applying pressure to the lower ABD to help expel the bladder

Define Multiple Sclerosis

A neurological and autoimmune disease affecting nerve cells in the brain an spinal cord that typically results in impaired and worsening function of voluntary muscles

A patient is suspected of having multiple sclerosis. The neurologist orders various test. The patient's MRI results are back and show lesions on the cerebellum and optic nerve. What signs and symptoms below would correlate with this MRI finding in a patient with multiple sclerosis? Select all that apply... A. Blurry vision B. Pain when moving eyes C. Dysarthria D. Balance and coordination issues E. "Pill rolling" of fingers and hands G. Heat intolerance H. Dark spots in vision I. Ptosis

A, B, C, D, H If lesions are present on the optic nerves, optic neuritis can occurs which can lead to blurry vision, pain when moving the eyes, and dark spots in the vision. If cerebellar lesions are found, this can affect movement, speech, and some cognitive abilities. This would present as dysarthria (issues articulating words), and balance/coordination issues. "Pill rolling" of the fingers and hands is found in Parkinson's disease. Ptosis is common in myasthenia gravis, and heat intolerance in thyroid issues.

A student is assisting the healthcare provider with the care of a patient diagnosed with multiple sclerosis (MS). The student correctly identifies which of the following as part of the pathophysiological process of MS? Select all that apply... A. Scarring and plaque development B. Hypoxic damage to cerebral tissue C. Deficiency of acetylcholine at the neuromuscular junction D. Axonal loss in the central nervous system E. Myelin regeneration and remission of symptoms F. Autoimmune damage to myelin sheath

A, B, D, F MS is characterized by inflammation, formation of demyelinating plaques, and axonal loss in the CNS.

A patient is prescribed high-dose methylprednisolone for an acute exacerbation of multiple sclerosis (MS). Which of these findings, if identified in the patient, would indicate the patient is experiencing an adverse effect of the medication? Select all that apply.. A.Epigastric pain B. Angioedema C. Hypokalemia D. Candida Infection E. Paralytic ileus F. Hyperglycemia

A, C, D, F By suppressing the inflammatory response, methylprednisolone inhibits the actions of leukocytes, thereby increasing the risk of opportunistic infections (e.g. Candida). Suppressing the inflammatory response also involves inhibition of COX-1, thereby increasing the patient's risk of gastric ulcers (which may be manifested by epigastric pain). Glucocorticoids such as methylprednisolone increases blood glucose levels and decreases serum potassium levels.

Which cytokine is used to treat multiple sclerosis? A. B-interferon B. Interleukin-1 C. Erythropoetien D. Colony-stimulating factor

A. B-interferon β-Interferon is a cytokine used to treat multiple sclerosis. Interleukin-2 is used to treat metastatic melanoma. Erythropoietin is a cytokine used to treat anemia related to chemotherapy. Colony-stimulating factor is a cytokine used to treat chemotherapy-induced neutropenia.

What is the likely initial event in the development of MS?

Activated T cells migrate into the CNS disrupting blood-brain barrier

At what age does MS typically become more progressive?

After 50 years old

List three emotional manifestations of MS

Anger Depression Euphoria

What is some objective data that can be seen in MS pt?

Apathy, inattentiveness Pressure ulcers Scanning speech Tremor Nystagmus Ataxia Spasticity

What should be assessed r/t drug therapy for MS?

Assess HTN and renal labs

_____ is an immunomodulatory agent with anti-inflammatory properties

Aubagio/Teriflunomide

What two medications are used to tx relapsing forms of MS?

Aubagio/Teriflunomide Gilenya/Figolimod

____ is a commonly used muscle relaxant for MS

Baclofen

Anticholinergics are used with MS pts to tx...

Bladder symptoms

The first three symptoms of MS may include....

Blurred of double vision Red-green color distortion Blindness in one eye

What part of the body is scanned in an MRI for a pt suspected with MS?

Brain and spinal chord

An MRI with a suspected MS pt will show...

Brain and spinal chord with the presence of plaques, inflammation, atrophy, and tissues breakdown and distraction.

Which medications below can help treat muscle spasms in a patient with multiple sclerosis? Select all that apply.. A. Propranolol B. Isoniazid C. Baclofen D. Diazepam E. Modafinil

C, D

Anti seizure drugs are given to pts with MS to tx...

Chronic pain

Explain relapsing-remitting MS....

Clearly defined attacks of worsening neurologic function (relapse) with partial or complete recovery (remitting)

What bowel and bladder functions may be impaired in a pt with MS?

Constipation Spastic bladder Flaccid bladder

The healthcare provider is planning care for a patient diagnosed with multiple sclerosis (MS). Which of the following is the priority intervention? A. Encourage bed rest in order to conserve strength B. Teach the patient's family how to meet the patient's needs C. Monitor the patient's temperature to avoid overheating D. Advise the patient to drink liquids through a straw

D. Advise the patient to drink liquids through a straw Problems related to dysphagia (such as aspiration) can be minimized if the patient drinks liquids through a straw. Sensitivity to heat is a concern with MS, but monitoring the patient's temperature is not necessary.

What are some findings r/t sexual activity in pt with MS?

ED Decreased libido Difficulty with orgasmic response Painful intercourse Decreased lubrication

What should the nurse encourage fluid intake with MS pt?

Encourage fluid intake to decrease risk of UTIs

Researchers suspect that exposure to _____ before puberty may predispose a person to develop MS later in life

Environmental agents

True or False: Corticosteroids are safe to use continuously in a patient with MS

FALSE

Cns stimulants are used to tx _____ for pt with MS

Fatigue

What is the Lhermitte's sign?

Feeling of being zapped or electrocuted r/t flexing the neck

A diet for a pt with MS should consist of high ____

Fiber

____ is an immunomodulatory agent that prevents lymphocytes from reaching the CNS and causing damage

Gilenya/Fingolimod

______ drugs are used initially to modify the disease progression and prevent relapse of MS

Immunomodulator drugs

What three types of drugs are used in MS to slow the progression of the disease?

Immunosuppressants Immunomodulators Adrenocorticotropic hormones

What at three popular nursing diagnosis for a pt with MS?

Impaired physical mobility Impaired urinary elimination Ineffective health management

Selective potassium channel blockers are used with MS pts to....

Increase nerve conduction

CSF analysis will depict _______ in pts with MS

Increased Immunoglobulin G and presence of oligoclonal banding

Use of interferon B-1a and B-1b and Glatiramer acetate increase pt's risk for....

Infection

What are some possible factors for the etiology of MS?

Infection Smoking Physical injury Emotional stress Pregnancy Poor state of health

What are the three Immunomodulator drugs used to modify disease progression in MS?

Interferon B-1a Interferon B-1b Glatiramer acetate

Nursing actions when MS pt is taking Baclofen....

Monitor liver function DONE STOP ABRUPTLY

What are the four main clinical manifestations of MS?

Motor problems Sensory problems Cerebellar problems Emotional problems

What happens to the myelin in MS when ongoing inflammation occurs?

Myelin loses the ability to regenerate

What happens if there is not myelin?

Permanent loss of nerve function

How long might it take before a patient with MS notices symptoms?

Possibly years

Does exacerbation of MS occur during pregnancy or post partum?

Post partum

_____ is the most common form of MS

Relapse-remitting

What effect does exercise have on MS?

Relieves spasticity Improves coordination Trains pt to substitute unaffected muscles for impaired muscles

What test is performed to confirm ataxia in pt with MS?

Romberg sign

How are the immunomodulator drugs administered to pt with MS?

Self administration subcu

Cognitive manifestations of MS create difficulties with....

Short-term memory Attention Information processing Planning Visual perception Word finding

Urinary leakage in a pt with MS puts them at greater risk for....

Skin breakdown

If muscle relaxants are deffective in tx spasticity in pt with MS, what three medical interventions may be required?

Surgery Dorsal column electrical stimulation Intrathecal baclofen pump

MS is more prevalent in ____ climates

Temperature changing climates

What is the action of corticosteroids in tx acute exacerbations of MS?

They reduce edema and acute inflammation at the site of demyelination

What is the cause of MS?

UNKNOWN

What are some triggers that can exacerbate MS?

Viruses and infectious agents Physical injury Emotional stress PREGNANCY Fatigue Overexertion Temperature extremes

What to monitor in pt with MS...

Visual acuity Speech patterns, fatigue with talking Swallowing Activity intolerance Skin integrity

Name five Motor manifestations of MS

Weakness or paralysis of limbs, trunk, and head Spasticity of muscles Scanning speech Hearing loss Tremors

Does MS affect men or women more?

Women

Is there a genetic component to MS?

Yes